Bloodletting and Germs: A Doctor in Nineteenth Century Rural New York

Book Title: Bloodletting and Germs: A Doctor in Nineteenth Century Rural New York

Author: Thomas C. Rosenthal

Publication Information: BookBaby (self-published), 2020, 336 pp., $18.99, paperback

Dr Jabez Allen: Table of Charges (1834)

…Ordinary Home Visit under one mile: $1

Each additional mile: 25¢ (Reduced if feed provided to doctor’s horse)

Obstetrics, ordinary, not over 6 hours: $5; complicated, $20 …

…Venesection (Including Bloodletting, cupping, blistering). Office: 50¢; in home: 75¢

Application of Leeches: $2 per application (may vary with market and availability)

Vaccination, single patient: $5

Pulling a tooth: 50¢

Extirpation of tonsils: $10

Cutting for bladder stones: $50

Removal of fingers or toes: $1

Removal of testicle: $25

Amputation (Leg, Arm): $30…

…Pumping stomach: $5 (p. 56).

This fictionalized account of the life of a real physician, Dr Jabez Allen, of Aurora, New York, immerses readers into the small-town practice of a young doctor in rural America. If you find the list of fees above entertaining, this book will be well worth your while.

The good doctor Allen arrives at a hotel in Aurora, where he stops for the night on his way to Cincinnati. The locals begin a successful campaign to recruit Dr Allen to build a practice in their town. This well-researched book walks alongside Dr Allen, armed with his newfangled stethoscope, as he finds a shop for his practice, hires an assistant, marries, builds a family, and becomes an integral part of his town. The book alternates between a richly detailed first-person narrative and copious historical asides, tracking the progress of medicine from bloodletting to germs.

This book is worthwhile on many levels. These include knowledge of local and national history, medical history, and the story of the protagonist himself. The author has clearly done a great deal of research into the cultural history of upstate New York in the 19th century. Debates about slavery and abolitionism, the activities of the local Underground Railroad, and the influence of Spiritualists all appear in this narrative. We learn about changes in the local economy wrought by the building of canals and railroads, the move from subsistence to commercial farming, and the influence of coal and steam engines. The section on local sanitation is eye-opening, including accounts of semiferal pigs roaming the streets and eating manure, and latrine and tannery wastes discharging into rivers.

Between culture and medicine reside the ubiquitous quacks and alternative healers, whose influence Dr Allen battles. A colorful character named Phineas J. McCarthy, claiming to have a medical degree, appears in town, selling his fraudulent remedy and charming the ladies. Through the efforts of our protagonist, the salesman’s lies are exposed, and McCarthy flees town during the night.

The medical history portion is where this book really shines. In Dr Allen’s early practice, the primary tools of the physician’s trade included frequent purging with bloodletting and with either senna or calomel (a mercury salt with strong laxative properties, Hg2Cl2, which fortunately does not absorb well into the gastrointestinal tract). The book provides a historical witticism about calomel’s explosive effects, “Within the past few days I have passed everything except my hat.” Dr Allen describes compounding most of his remedies himself, which is fascinating.

Dr Allen joins the Lake Erie Medical Society, and becomes an active participant. He acquires up-to-date equipment and keeps up with medical research amazingly well, through reading and participation in professional meetings. A particularly interesting chapter entitled “Germs” (p. 295) chronicles the proceedings of the American Medical Association’s 1878 meeting in Buffalo. There ensues a spirited debate between those physicians who believe in germ theory, and those who are reluctant to part with beloved theories about miasmas and moral weakness, intemperance, or an imbalance of humors being the causes of disease. Rosenthal summarizes the results of this contentious conference as follows:

The official minutes simply stated that some members believed germs might eventually explain the occasional epidemic and some inflammations. The committee’s output was a resolution much like the previous year’s. It recommended streets and homes be kept clean and all households should have access to clean water and nutritious food. (p. 302)

The book suffers from a few weaknesses. It is self-published, and the lack of an editor shows in occasional errors in usage or syntax. Also, the language and concepts can be anachronistic, as for example when the author uses the term “status symbol” (p. 254) before that term was coined.

But all nit-picking aside, the modern language makes the book accessible to the general reader, and the author’s love for that era shines through. Bloodletting and Germs is an enjoyable read, full of rich details that make the story compelling. It could serve as a valuable text for a “History of American Medicine” seminar. Most importantly, Dr Rosenthal implicitly invites us to be humble about the current state of our knowledge in medicine, and to nurture the spirit of intellectual curiosity, along with the kindness and generosity, exemplified by Dr Jabez Allen.